Podcasts about high risk patients

Reference: Bannelier et al. Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies. AEM Feb 2025 Date: February 27, 2025 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is […] The post SGEM#469: You Take My Breath Away – D-dimer for Ruling out PE in High-Risk Patients first appeared on The Skeptics Guide to Emergency Medicine.

Send us a textOn this encore episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss how artificial intelligence (AI) significantly improves the identification of hospital patients at risk of clinical deterioration compared to physician assessments alone. They are joined by Dr. Amol Verma, a general internist at St. Michael's Hospital in Toronto, an associate professor at the University of Toronto, and the holder of the Temerty Professorship in AI Research and Education, who shares findings from his recent CMAJ article, “Clinical evaluation of a machine learning-based early warning system for patient deterioration”.Dr. Verma explains how the AI system, ChartWatch, analyzes over 100 variables from a patient's electronic medical record to predict deterioration more accurately than traditional early warning scores like the NEWS score. He discusses how the integration of AI into clinical workflows improves patient outcomes by complementing human decision-making, leading to better results than relying on physicians or AI alone.The episode also looks at the potential future of AI in medicine, with Dr. Verma sharing insights on how AI tools should be thoughtfully integrated to support clinicians without overwhelming them. He stresses the need for AI systems to fit seamlessly into clinical workflows, ensuring patient care remains the priority. While AI is currently a tool to assist clinicians, Dr. Verma argues that the full extent of AI's role in healthcare—and its impact on the physician's place within it—remains ultimately unknowable.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

In today's healthcare landscape, managing and presenting major adverse events poses significant challenges for healthcare professionals all over the world. In this episode, Prof. Michel Struys and Mr. Andreas Schabbach aim to explore advanced predictive technologies as a possible solution to this kind of challenge. Join them in their discussion and find out more.Supported by Nihon Kohden

Bonnie Ky, MD, and Marcely Gimenes Bonatto, MD, discuss the study design, findings, future research questions and the potential clinical impact of the use of sacubitril/valsartan for the prevention of cardiotoxicity in high-risk patients undergoing anthracycline chemotherapy.

Send us a textOn this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss how artificial intelligence (AI) significantly improves the identification of hospital patients at risk of clinical deterioration compared to physician assessments alone. They are joined by Dr. Amol Verma, a general internist at St. Michael's Hospital in Toronto, an associate professor at the University of Toronto, and the holder of the Temerty Professorship in AI Research and Education, who shares findings from his recent CMAJ article, “Clinical evaluation of a machine learning-based early warning system for patient deterioration”.Dr. Verma explains how the AI system, ChartWatch, analyzes over 100 variables from a patient's electronic medical record to predict deterioration more accurately than traditional early warning scores like the NEWS score. He discusses how the integration of AI into clinical workflows improves patient outcomes by complementing human decision-making, leading to better results than relying on physicians or AI alone.The episode also looks at the potential future of AI in medicine, with Dr. Verma sharing insights on how AI tools should be thoughtfully integrated to support clinicians without overwhelming them. He stresses the need for AI systems to fit seamlessly into clinical workflows, ensuring patient care remains the priority. While AI is currently a tool to assist clinicians, Dr. Verma argues that the full extent of AI's role in healthcare—and its impact on the physician's place within it—remains ultimately unknowable.For more information from our sponsor, go to medicuspensionplan.comJoin us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Send us a Text Message.In der aktuellen Folge des HAINS Journal Clubs geht es um das iPEGASUS-Trial von Funcke et al. aus dem BJA zur Cardiac Index-gesteuerten hämodynamischen Therapie:Funcke S, Schmidt G, Bergholz A, et al. Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery: the multicentre randomised iPEGASUS trial. Br J Anaesth. 2024;133(2):277-287. doi:10.1016/j.bja.2024.03.040Vorgestellt wird die Arbeit von Dr. Anja Schuh, wissenschaftliche Mitarbeiterin der Klinik für Anästhesiologie am UKHD. 

Host Dr. Davide Soldato interviews Dr. Sana Raoof to discuss the JCO article Turning the Knobs on Screening Liquid Biopsies for High-Risk Populations: Potential for Dialing Down Invasive Procedures. TRANSCRIPT Dr. Davide Soldato: Hello, and welcome to JCO After Hours, the podcast where we sit down with others from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, Medical Oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. Sana Raoof, Physician at Memorial Sloan Kettering, to talk about her article, “Turning the Knobs on Screening Liquid Biopsies for High-Risk Populations: Potential for Dialing Down Invasive Procedures.”   Thank you for joining us today, Dr. Raoof. Dr. Sana Raoof: Thank you so much. It's lovely to be here. Dr. Davide Soldato: So, Dr. Raoof, I just wanted to start a little bit about the theme of your article, which is really centered around multi-cancer early detection tests. And this comes from the results of several studies that showed their reliability and efficacy in identifying cancer in the average risk population. But I just wanted to ask you if you could give us and our readers a brief overview of how these tests work and how they were designed for this specific population. Dr. Sana Raoof: Of course. Well, there's an interesting story. The origin of multi-cancer early detection tests actually begins with insights that come from the field of obstetrics and gynecology. So about six or seven years ago, in the peripheral blood of pregnant women, we discovered that you can actually find fetal DNA floating around. And that was an early discovery of cell free DNA coming from the baby into the mother's bloodstream. But in some of those young, otherwise healthy women, we also discovered that there's another clonal signal, unfortunately not coming from the fetus, but coming from an undiagnosed tumor. And that led to the entire field of circulating tumor DNA and all of its applications.  Of course, scientists in the last six or seven years have harnessed the fact that DNA and the methylation patterns on the circulating tumor DNA, as well as other analytes like glycosaminoglycans, proteins, and other analytes, are secreted by tumors into the peripheral blood in order to try and screen for tumors, hopefully at early stages, when there are still curative, definitive interventions that are available. There's several different tests now that are providing the ability to detect cancers at many stages, including early stages. They're in different phases of preclinical to clinical development, and one is even commercialized and available by prescription in the United States. Dr. Davide Soldato: Okay. So I think that in most of these tests, they really look at the tumor DNA, so they identify mutations or, for example, methylation patterns. But do we also have some tests that integrate some other type of biomarkers that we can identify in the blood? Like, are they integrated all with the others, or are we just relying on circulating tumor DNA? Dr. Sana Raoof: It's a great question. There's a lot of really fascinating biology that different companies predominantly are using in order to find signs of early cancer. One of the analytes that I find really interesting, other than looking for small variants in circulating tumor DNA and looking at methylation patterns, as you mentioned, is looking at fragment length. So, for example, the company DELFI looks at the different patterns of the length of DNA fragments that are floating around in the peripheral blood. And not only is fragment length tissue specific, so in theory, a fragmentomics based multi-cancer early detection test could tell us what is the tissue that this aberrant signal is coming from, but they can also tell you if there's likely a cancer present, because there's a difference in fragment length patterns in cancer versus non cancer.  There are also other analytes. I mentioned glycosaminoglycan. There's another company that doesn't yet have prospective data, to my knowledge, that is making a test that looks at these analytes instead. There are other companies, again, without prospective data yet, that are looking at circulating tumor cells. And I'm sure that in the next few years, we're going to start getting prospective data from all of these players and also hear about other analytes that scientists have found can predict cancer from non cancer and maybe even protect tissue of origin based on artificial intelligence. Dr. Davide Soldato: So you mentioned artificial intelligence. So, basically what you're suggesting, but correct me if I'm wrong, is that when we use this test, we are actually measuring something in the bloodstream, but at the same time, we are actually applying some type of artificial intelligence to actually interpret these results and then give us the definitive results, or what we would call like a positive and a negative of the tests, is that right? Dr. Sana Raoof: Yeah, absolutely. And it's an important distinction that you're making, we are measuring something in the blood, but we're not just measuring it. We're using machine learning algorithms that have been trained on thousands and thousands of patients with cancer and thousands and thousands of patients without cancer, and have measured various analytes and analyzed the patterns, for example, of DNA sequence, or bisulfite sequencing of methylation patterns of patients with and without cancer, and have been trained to look for the differences between them. And so the analyte that we're looking for is not a specific mutation per se, but is a pattern that looks like patterns that you typically find more so in cancer patients.   There's many different companies, they are trained on different types of cancer. So some companies, like GRAIL, have a test that looks for a very expanded list of over 50 cancer types. Other tests have a narrower focus and were trained and validated on a smaller list of cancer types. So there's just a great diversity in this space. These tests are trained to look for different types of cancer. They're trained and validated on different populations of interest. So, for example, some of the populations that these tests were trained on are predominantly white, and that will have impacts, potentially on how these tests perform in non-white populations. And that's a really interesting area of future research. These tests may or may not have included cancer survivors in their populations, and that could ultimately impact how these tests perform in those populations.  So there's just so much to learn, so much data that's going to be coming out in the next few years from all of these different key players in the multi-cancer early detection space. But one thing that I'm sure of is between all of the different analytes, all of the different training and validation studies, and all of the different prospective studies, we're going to learn a tremendous amount about the potential clinical utility of using multi-cancer early detection tests to complement the few standard of care surveillance cancer screening tests that we have recommended today. Dr. Davide Soldato: So just taking a step back and going back to the fact that we actually use machine learning algorithms to identify a pattern that can give us an idea of whether cancer is present or not, I believe that there is also some room for calibration of these types of tests. And I think that this is one of the key arguments that you make in your paper where you say that we can actually personalize a little bit more these types of tests to understand and then to decide what we are looking for. Is that correct and can you expand a little bit on that? Dr.Sana Raoof: Yeah, absolutely. This is the central concept of the paper that we're discussing. Because these tests are machine learning based, as I said, they're trained to say cancer versus not cancer, and some of them are further trained to say, coming from this organ or coming from that organ. But what does it mean to say cancer or not cancer? There are specific thresholds that are defined to say, above this threshold of signal detection, we're going to say this is a positive cancer signal detected, and below it we're going to say negative. And so right now, these tests are kind of designed to have this binary output, and the concept that I wanted to put forth in the paper is it doesn't necessarily have to be binary, and the thresholds don't have to be static. So, for example, you can imagine that in an average risk population where the pretest probability of cancer in your lifetime for Americans, it's pretty high, roughly 40% for lifetime. But at any given moment in time when you're getting a test, it's lower. For example, in Americans, 50 to 80, the chance of having cancer at any given moment is just under 3%. So you don't necessarily want a test that is very nonspecific, you don't necessarily want to tell a lot of perfectly healthy people that are asymptomatic screening populations that they have cancer if they don't. And so these tests were designed to have very high specificity, predominantly across the board, across the different companies making them at the cost of, in some cases, having lower or moderate sensitivity in early stages.   And it's important to keep in the back of your mind that we cannot ever expect the types of early stage sensitivities from multi-cancer early detection tests that we're used to thinking about for single cancer screens that are just optimized for one single organ. They work in a completely different way. So I don't expect a future where the sensitivity of a mammogram, which is only for breast cancer, is going to be analogous to the sensitivity of a blood-based test that's looking for all cancers in your entire body. I don't think it's fair to expect that. But I do think it's possible to imagine a future where we do change the thresholding of these tests that were trained and validated in average risk screening populations, and say, “Let's turn the knob on the dial and let's take the sensitivity a little bit higher, even if it means the specificity drops from 99%, for example, which is the very high number of the gallery test, down to 98%, down to 97%. Let's see how this affects the positive predictive value and the negative predictive value of the test.” And how having a higher negative predictive value by having a higher sensitivity may or may not make it more clinically useful for higher risk populations that have higher pretest probabilities, in which case we are kind of more interested in being sure that we're ruling out cancer.  Another concept that I talk about in the paper, aside from just turning the knobs, is to make it a continuous variable rather than a binary report. Rather than saying signal detected or not signal detected, I can also imagine a future where we personalize the output of multi-cancer early detection tests to return a score, for example, from 1 to 100 or 1 to 10, and give physicians the ability to use that continuous variable in addition with other clinical findings, physical exam findings, other labs, symptoms, patient's past medical history, family history, all of that together to make decisions about should we pursue further workup, should we do an invasive biopsy. This is kind of the way that we use other scoring tests in oncology, like the oncotype tests for breast cancer, decipher test in prostate cancer. And I think physicians like having continuous variables to work with and to help them make very personal decisions for patients' diagnostic workups. Dr. Davide Soldato: To summarize a little bit, what you're arguing in the paper is that we could potentially modify a little bit these tests as they fit the type of population that we are looking for. For example, if we are looking at the average risk person in America, there we just want to be sure that we are just doing additional workout and additional follow ups and additional invasive procedure, for example, biopsy, when we have a very high probability of finding that cancer. At the same time, if we have someone who has a baseline risk which is higher, like cancer survivors, in that case, we are more interested in seeing if there is really cancer at that point, and so we can increase the sensitivity and go down on specificity, but still looking at the overall outcome that we want to have for that specific patient.  One thing that I was wondering is, do you also see a future where we personalize a little bit more also including additional information that comes from risk factors, environmental or behavioral patterns, type of diet, or these types of risk factors that we already know from epidemiology are associated with a higher risk? So could we potentially customize this test even more, saying, this patient has a higher risk of developing colorectal cancer, so could we look more specifically to that specific cancer type and that specific risk compared to tobacco associated cancers, that for that specific patient, they are not so relevant?  Dr. Sana Raoof: What you're saying is actually a fascinating and really compelling idea, and it reminds me of the way that noninvasive prenatal testing works. So, again, back to the world of obstetrics and gynecology, you have a woman at the end of her first trimester having fetal DNA testing to look for chromosomal abnormalities. And when you order that test, you actually do put in various features about the woman to help you understand her baseline risk for carrying a fetus that has chromosomal abnormalities, including her age, the status of her other children, and other things in order to help you calculate a pretest probability. And so after that, the non invasive prenatal test takes that into consideration and returns a probability of carrying a fetus that might have those aberrations, and it's not a binary risk. It's, as I said, a continuous variable. So I think what you're proposing actually goes beyond what I wrote about in the article. I think it's a fabulous idea. And I think that in the near future, I can imagine that as natural language processing is exploding, and in general, large language models and the ability to extract features about a patient from the EMR are exploding, we might have a better stratification in general of patients into average risk, low risk, high risk, and really high risk, using EMR data, using real world data that could help us feed a really accurate picture of a patient's pre-test probability into this test, so that these tests could be further refined and further trained and validated on patients, taking into consideration more factors and help us improve the predictive power of the tests as they're returned in a report to the physician. So I think maybe you should even write an article about the idea just proposed. It's a great idea. Dr. Davide Soldato: So another aspect that I was really interested in is I've looked at one of the papers that you cited, and I wanted to discuss this with you as you are an expert on the topic. In one of the articles that you cited that used this type of test, they identified some of the cancers that we also normally identified with standard screening procedures, like breast or lung or colorectal. So for those cancers, we add a certain proportion, or like, for example, for breast cancer, a higher proportion identified with conventional screening. But still we had some other cancer that eluded those types of screening and were identified using liquid biopsy tools. So do you envision a strategy where we would use the screening methods that we already add as a complement to those liquid biopsies, or do you think that someday liquid biopsy could potentially completely substitute standard screening procedures?  Dr. Sana Raoof: I think we're too far from a day where liquid biopsies are going to replace standard of care screens. The scope scans and smears that the United States Preventive Services Task Force has recommended are gold standard screening interventions because, number one, for all of them, except for cervical cancer screening, we have randomized data with definitive endpoints that tell us that there are mortality benefits from doing those screens. We don't have that type of data yet from the world of multi-cancer early detection. And as we talked about earlier in this podcast, those tests are kind of designed with a different approach where they have higher sensitivity and much lower specificity than multi-cancer early detection tests.  So I think that the molecular cancer screening companies have done a very careful job of creating tests that are really more optimized to be complementary tests rather than a standalone catch all test, to have higher specificity at the cost of lower sensitivity. So I don't imagine a near future, at least not in my career, where we're going to stop doing colonoscopies and mammograms and pap smears. I don't think that that's going to happen. But I do think that whereas right now 75% of cancers that Americans die from, we lack cancer screening mechanisms for them, I think that that number has the potential to really drop. If in the next few years, one of these multi-cancer early detection tests is ultimately approved and covered, then I think that a lot more cancers could be detected by screening rather than by symptoms, and we might ultimately see a big stage shift.  Dr. Davide Soldato: Yeah, I think you're absolutely right. In the same article that I was mentioning before, there were several of those cancers which can be lethal if diagnosed at an advanced stage, that were diagnosed at an early stage, for example, ovarian cancer, bladder cancer. So I really think that we really have potentially the way to screen, or at least have a signal for cancer that currently we just diagnosed when symptoms associated with higher stage appear.  But moving on to turning the knobs on this type of test, and so going to the higher risk population, for example, cancer survivors, which is something that you speak a lot about in the manuscript. So you also discuss a little bit the question of whether we should use multi-cancer testing versus single cancer testing. So are we looking at a specific recurrence from that specific tumor, or are we looking at a general risk of cancer in a population that has a common risk factor, like tobacco? And so I was wondering if you think, and this is probably just your perception or just your opinion, that that is another way that the physician should turn the knob. Should we evaluate the risk of those cancer survivors and say, in this specific patient right now, the risk of recurrence is higher so I should use or I should be more in favor of a test that is more centered on the risk of recurrence versus I have a general risk of several cancers that could appear, and so should I use something that is more multi-cancer? This, of course, is merely speculative because we still don't have definitive data regarding the efficacy of this test. But it is just your perspective on this type of approach in the near future or not so near future.  Dr. Sana Raoof: Well, I think if we're speculating, then I think that the fantasy situation for any oncologist is that you have two types of liquid biopsies. One is a multi-cancer early detection liquid biopsy. And it would be great if you could select whether you want it to be optimized for highest NPV, negative predictive value, or highest PPV, positive predictive value. And then you also have a host of single cancer screening liquid biopsies that can help you specifically figure out if there's a recurrence of a single cancer type that you're suspicious about.   So, for example, in the article, I talk about how there will be clinical gray areas, and it's not always going to be obvious which test you should reach for. But one example that I think we can all relate to in the oncology community is you have some indeterminate imaging finding, and you don't know what to do about it. So, for example, you have a woman that has a history of breast cancer, has had no evidence of disease for a few years, now, has back pain. You do a spine MRI, you see a lesion. Maybe it's an atypical hemangioma that's causing pain, maybe it's a breast cancer metastasis. You're not sure. What should you do? Should you do a biopsy of that lesion in the spine? Should you wait and see if it grows and do another MRI in two or three months? What are your options? And so in this situation, I think we can all agree that if you had a liquid biopsy that was optimized for really high sensitivity, specifically for breast cancer, and had a very high negative predictive value, and if it came back negative, then in that setting, it might help you avoid an invasive test, like a biopsy in the spine, and give you a little bit more comfort as a physician to say, “You know what? I'm going to come back in two or three months and do another spine MRI. I'm going to see how this woman is feeling, and I don't need to biopsy this right now. Maybe it really is just hemangioma.”  Dr. Davide Soldato: And in this specific setting, let's take the same patient. So it's a female patient, she had a previous diagnosis of breast cancer. Do you think that there is a difference between tumor-informed tests, really based on the molecular aberration that the primary tumor had for these women, versus just a standard test that gives us information regarding the presence of breast cancer cells or not? And if you think that there is a difference, what would you think would be the advantage of one? And the disadvantages, for example, is a tumor informed essay more complex to obtain? Do we need more time? Is it more expensive versus a commercial test that is already available or something like this? This is my understanding as someone who's not so much in the topic, but I think that this is a point that many oncologists probably wonder about, and probably we should speak a little bit more about with someone who is an expert on the topic.  Dr. Sana Raoof: Absolutely. And I think that you've actually hit all of the major points on the head. So comparing a tumor informed versus a tumor agnostic test is like really comparing apples and oranges. A tumor informed test where you're starting with a patient's pathology and you are looking specifically for mutations and other molecular features that you know the patient has in their tumor, is going to, of course, result in a test that is, number one, more expensive and harder to make, but also, number two, more sensitive, more specific, more predictive, and in every way probably just more powerful than a test that is, in general, optimized for a single cancer type, but is almost certainly going to be trained and validated on people with a mix of histologies, a mix of molecular features, and will not be as sensitive or specific as a test that is actually informed by that single individual's tumor. One of the things that matters a lot to me is health equity in oncology. There are just huge disparities in outcomes in patients that are advantaged and disadvantaged. And it stems from lots of different things. In no small part, it stems from later stages of diagnosis in disadvantaged patients, and then even once you have a diagnosis, delays to confirmatory workup, delays to starting treatment, disparities in the treatments offered.  I don't imagine a world where everyone on earth is going to have access to tumor-informed liquid biopsies. I do imagine a future where tumor agnostic liquid biopsies, both for single and multi-cancer screening, should be a lot more economical than they are now, and should be more available for multiple cancer types, and should be more available to patients that aren't at just the Memorial Sloan Ketterings and the Dana-Farbers of the world. And so I do think that those types of off the shelf tests have the potential to really revolutionize the way that we work up suspicion of cancer, not just in advantaged patients, but also in patients that are diverse, in patients that are not at academic cancer centers, but at other cancer centers around the world. And I think it's a really exciting prospect.   Thinking about the chance of recurrence in the breast cancer patient is a perfect example of when you want to test that is optimized just for breast cancer, because you see something in the spine, you know her history, and you're less worried about a new primary and a new MET from that primary. But there are other situations that are also interesting to consider. For example, patients that have had lung cancer and have a history of smoking, because they've had a history of smoking, they're actually at risk for a dozen different cancers, not just lung cancer. And when you think about what we do to follow lung cancer survivors, we're just doing CTs of their chest and of course, physical exams. But the vast majority of cancers that people with lung cancer history will get may not be present in the field of view of a CT of the chest. They may also get renal cancer, bladder cancer, they might get leukemias, they might get pancreatic cancer. So there are a lot of things that you're not going to catch in a CT of the chest. And so in that situation, you care not only about recurrences, which in thoracic oncology, it's kind of a gaussian probability distribution, where the tail is almost close to 0 after five years, but also a uniform distribution of roughly 3% per year of a second cancer, a new primary cancer that goes on for the rest of their life. And so in that clinical setting, you can imagine that having an off the shelf multi-cancer early detection test may be dialed up for higher negative predictive value, would be extremely useful. Dr. Davide Soldato: Yeah, I totally agree, but thank you for clarifying these points, because I think that there is a little bit of confusion also in the oncology community, as this type of tests, they're also based on very complicated molecular biology, sometimes could be potentially integrated, and we could potentially integrate them in the clinic.  And so I wanted to close up with kind of a personal question. I was wondering how you came to be so interested in this field of molecular screening or early diagnosis and prevention associated with molecular data.  Dr. Sana Raoof: Well, it's an interesting story. I did my MD PhD at Harvard Medical School, and my PhD was in the opposite world from molecular cancer screening. I was designing drug combinations that could be used in advanced oncogene mutant lung cancers. And I thought I would become a medical oncologist and spend my life designing new systemic therapies for advanced malignancies. And what I saw every day in the lab during my PhD is drug resistance emerges and it's a process of evolution by natural selection happening on a cellular level. And although we have some really great slam dunk drugs that come to mind, for example EGFR inhibitors in certain lung cancers, immunotherapy in melanoma, on average, the median overall survival gain from all of the FDA approved drugs in the last 10 years is roughly two months.   By the end of my PhD, I really started feeling like, is the best use of my life to continue fighting a battle against natural selection in cancer cells, or is it a better strategy, to me, it seemed like a more sensical strategy to just try and find cancers in these patients earlier, when you don't have to engage with the complex signaling mechanisms of a cancer cells biology, and instead can just provide a definitive local intervention, like surgery or radiation, which already is curing many patients with non metastatic cancers. And as I looked around the world, I just didn't see that many people investing heavily in early detection research at the time. It was the very early days of multi-cancer early detection. And so I became involved with all of the groups, the companies, the organizations that were developing these tests, and really fell in love with, number one, just the concept of the tests, the concept of multi-cancer early detection, rather than single cancer screening alone, because no one knows what cancer they're ultimately going to get. But I also really fell in love with methylation biology, fragmentomics. I fell in love with the types of clinical trials that were being designed and the new types of endpoints that we have to think about when we're designing clinical trials for a multiverse of single cancer screening. And it's just such an exciting time in that community, it's the early days. So that's how I came to this space, and it's just the perfect time to be in this space, because everything is exploding.  Dr. Davide Soldato: Thank you very much. And thank you also for sharing the personal side of the story. Dr. Sana Raoof: Thank you so much. I'd like to thank Razelle Kurzrock, who's an amazing medical oncologist who's worked with me on two really fun papers so far, one on real world data, and this one on turning the knobs on liquid biopsies. It's always great to bounce ideas around about multi-cancer early detection with friends and collaborators, and Razelle did an absolutely amazing job helping write this piece.  Dr. Davide Soldato: So this brings us to the end of the episode. Thank you Dr. Raoof, for joining us and sharing more on your JCO article titled, ”Turning the Knobs on Screening Liquid Biopsies for High-Risk Populations: Potential for Dialing Down Invasive Procedures.”   If you enjoy our show, please leave us a rating and review, and be sure to come back for another episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Disclosures: Dr. Raoof Stock and Other Ownership Interests Company name: Illumina Radiopharmaceuticals Honoraria Company name: AstraZeneca Consulting or Advisory Role Company name: Verily Company name: GRAIL Company name: Exact Sciences Travel, Accommodations, Expenses Company name: Grail    

This machine learning algorithm runs nightly and is linked to a smart texting application that goes out to patients every morning for 7 days following chemotherapy, asking about symptoms like diarrhea, fever, nausea, vomiting, and pain. Patients reporting severe or worsening symptoms have the smart text escalated to the oncology clinic where they received chemotherapy. Initial analysis broken down by responders (those that opted in and answered the daily text messages) and non-responders (opted out or opted in but did not answer the texts) found that ED visits were 5.7% for responders compared to 6.7% for non-responders. Across the health system, about 30 responders are added daily to the program. Guest: Michelle Eichelmann Executive Director, Oncology Services and Precision Medicine Mercy, Mercy Oncology Services Saint Louis, Missouri   “It's one thing to mine data out of our EMR, but to actually use it in a proactive approach to patients I think is very unique. That's the key behind this...not just data, but what do we do with the data?” —Michelle Eichelmann Hear more about this innovation at the ACCC 41st National Oncology Conference, October 9-11, 2024, in Minneapolis, Minnesota.   Additional Resources: Smart-Texting High-Risk Patients After Chemotherapy Reduces ED Visits – ACCCBUZZ Blog Reducing ED Visits and Hospital Admissions after Chemotherapy with Predictive Modeling of Risk Factors Utilizing Technology to Identify Patient Co-Morbidities and Reduce Hospital and ED Admissions ACCC 41st National Oncology Conference Registration

This machine learning algorithm runs nightly and is linked to a smart texting application that goes out to patients every morning for 7 days following chemotherapy, asking about symptoms like diarrhea, fever, nausea, vomiting, and pain. Patients reporting severe or worsening symptoms have the smart text escalated to the oncology clinic where they received chemotherapy. Initial analysis broken down by responders (those that opted in and answered the daily text messages) and non-responders (opted out or opted in but did not answer the texts) found that ED visits were 5.7% for responders compared to 6.7% for non-responders. Across the health system, about 30 responders are added daily to the program. Guest: Michelle Eichelmann Executive Director, Oncology Services and Precision Medicine Mercy, Mercy Oncology Services Saint Louis, Missouri   “It's one thing to mine data out of our EMR, but to actually use it in a proactive approach to patients I think is very unique. That's the key behind this...not just data, but what do we do with the data?” —Michelle Eichelmann Hear more about this innovation at the ACCC 41st National Oncology Conference, October 9-11, 2024, in Minneapolis, Minnesota.   Additional Resources: Smart-Texting High-Risk Patients After Chemotherapy Reduces ED Visits – ACCCBUZZ Blog Reducing ED Visits and Hospital Admissions after Chemotherapy with Predictive Modeling of Risk Factors Utilizing Technology to Identify Patient Co-Morbidities and Reduce Hospital and ED Admissions ACCC 41st National Oncology Conference Registration

An artificial intelligence (AI) system trained with electrocardiogram (ECG) tests has been proven to reduce the risk of death among high-risk patients by 31 percent, according to a clinical trial conducted at two Taiwanese hospitals. The AI system, which analyzed the heart test results of nearly 16,000 patients, was able to identify patients at high risk of dying based on their ECG results and alert physicians for further evaluation and treatment. The study showcases the potential of AI in healthcare, suggesting that implementing similar AI systems in hospitals worldwide can significantly reduce mortality rates and improve patient outcomes. --- Send in a voice message: https://podcasters.spotify.com/pod/show/tonyphoang/message

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Guest: Stephen I. Pelton, MD Influenza disproportionately affects adults 65 and older as a result of increased frequency of comorbidities and immunosenescence.1,2 And it's also linked to neurologic, cardiovascular, and respiratory complications in high-risk groups, while potentially exacerbating underlying chronic medical conditions.1,2 So how can adjuvanted vaccines help patients who are affected? Dive in to learn more with Dr. Stephen Pelton, Professor of Pediatrics at Boston University Chobanian and Avedisian School of Medicine. References: Pelton SI, Nguyen VH, Mould-Quevedo JF. The value of influenza vaccination in the older adult population. A stochastic model estimation of the benefit of vaccination to prevent the severe outcomes in the U.S. Poster presented at: IDWeek 2023; October 11-15; Boston, MA. Pelton SI, Mould-Quevedo JF, Nguyen VH. The impact of adjuvanted influenza vaccine on disease severity in the US: a stochastic model. Vaccines. 2023; 11(10):1525. https://doi.org/10.3390/vaccines11101525 USA-FLUD-23-0011 12/23

Guest: Stephen I. Pelton, MD Influenza disproportionately affects adults 65 and older as a result of increased frequency of comorbidities and immunosenescence.1,2 And it's also linked to neurologic, cardiovascular, and respiratory complications in high-risk groups, while potentially exacerbating underlying chronic medical conditions.1,2 So how can adjuvanted vaccines help patients who are affected? Dive in to learn more with Dr. Stephen Pelton, Professor of Pediatrics at Boston University Chobanian and Avedisian School of Medicine. References: Pelton SI, Nguyen VH, Mould-Quevedo JF. The value of influenza vaccination in the older adult population. A stochastic model estimation of the benefit of vaccination to prevent the severe outcomes in the U.S. Poster presented at: IDWeek 2023; October 11-15; Boston, MA. Pelton SI, Mould-Quevedo JF, Nguyen VH. The impact of adjuvanted influenza vaccine on disease severity in the US: a stochastic model. Vaccines. 2023; 11(10):1525. https://doi.org/10.3390/vaccines11101525 USA-FLUD-23-0011 12/23

This recording features audio versions of January 2024 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Association between End-Stage Renal Disease and Major Adverse Limb Events after Peripheral Vascular Intervention ReadPercutaneous CT-Guided Cryoablation for Locally Recurrent Prostate Cancer: Technical Feasibility, Safety, and Effectiveness ReadHydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain ReadProgression toward Vertebral Collapse of Vertebral Metastases Treated with Percutaneous Vertebroplasty: Rate and Risk Factors ReadA Pilot Study of Percutaneous Cholecystoenteric Anastomosis: A New Option for High-Risk Patients with Symptomatic Gallstones ReadMeasurement of the Tumor-to-Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-Dimensional Perfusion Angiography, Technetium-99m Macroaggregated Albumin, and Yttrium-90 SPECT/CT ReadJVIR and SIR thank all those who helped record this episode:Host:Rommell Noche, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutAudio editor:Siddhi Hegde, MBBS, Massachusetts General HospitalAbstract readers:Justin Cook, University of Central Florida College of MedicineColin Standifird, Kirk Kerkorian School of Medicine at University of Nevada, Las VegasAnna Hu, George Washington University School of Medicine and Health Sciences, D.C.Jack Ficke, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutEric Chang, MS, University of Illinois College of MedicineBrian Ng, Saint Louis University School of Medicine, Missouri©  Society of Interventional RadiologySupport the show

Brian Smith, Chief Pharmacy Officer at Shields Health Solutions, addresses the challenges patients experience receiving specialty drugs by working with health systems to simplify the process. With a focus on measuring outcomes and improving patient care, Shields has seen a significant cure rate for hepatitis C, driven by attention to medication adherence and tracking outcomes. Recognizing the need to treat the multiple conditions patients often experience, Shields takes a patient-centric view to help these high-risk patients keep their conditions under control.   Brian explains, "We started in the areas of what people would call specialty pharmacy, such as oncology medications that people take at home, oral medications for people who have had a transplant, and injections like Humira for rheumatoid arthritis." "But I'd say what we found over the last 12 years is a lot of medications can be challenging and difficult, and a lot of patients need help. While we focus on specialty pharmacy, I'd say we have broadened ourselves to focus on high-risk patients with a lot of needs." "When we support our specialty patients, and I had the little quotations on my fingers here, we view them holistically. If the patient chooses, we try to support all of their medications, which helps them a lot, as well as dealing with one pharmacy, one call a month, to remind them of their refills for any and every medication they might need. It simplifies things for their providers as well, where it's a lot easier to screen for things like drug interactions and other challenges that can happen with polypharmacy." #ShieldsRx #SpecialtyPharmacy #ElevatingSpecialtyPharmacy #RareDiseases #HepC shieldshealthsolutions.com Listen to the podcast here

Brian Smith, Chief Pharmacy Officer at Shields Health Solutions, addresses the challenges patients experience receiving specialty drugs by working with health systems to simplify the process. With a focus on measuring outcomes and improving patient care, Shields has seen a significant cure rate for hepatitis C, driven by attention to medication adherence and tracking outcomes. Recognizing the need to treat the multiple conditions patients often experience, Shields takes a patient-centric view to help these high-risk patients keep their conditions under control.   Brian explains, "We started in the areas of what people would call specialty pharmacy, such as oncology medications that people take at home, oral medications for people who have had a transplant, and injections like Humira for rheumatoid arthritis." "But I'd say what we found over the last 12 years is a lot of medications can be challenging and difficult, and a lot of patients need help. While we focus on specialty pharmacy, I'd say we have broadened ourselves to focus on high-risk patients with a lot of needs." "When we support our specialty patients, and I had the little quotations on my fingers here, we view them holistically. If the patient chooses, we try to support all of their medications, which helps them a lot, as well as dealing with one pharmacy, one call a month, to remind them of their refills for any and every medication they might need. It simplifies things for their providers as well, where it's a lot easier to screen for things like drug interactions and other challenges that can happen with polypharmacy." #ShieldsRx #SpecialtyPharmacy #ElevatingSpecialtyPharmacy #RareDiseases #HepC shieldshealthsolutions.com Download the transcript here

How do your nonalcoholic steatohepatitis (NASH) management strategies compare with that of the experts? Credit available for this activity expires: 7/31/2024 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/994936?ecd=bdc_podcast_libsyn_mscpedu

CME credits: 0.25 Valid until: 15-06-2024 Claim your CME credit at https://reachmd.com/programs/cme/hpv-vaccination-rates-in-mid-adult-and-high-risk-patients-strategies-for-improvement/15430/ HPV vaccination guidance for mid-aged adults (27 to 45 years old) was updated by the CDC in 2019. Unfortunately, very few individuals in the US in this age range have ever been vaccinated for HPV, despite the risk for acquiring an HPV infection that can potentially progress to cancer, most notably oropharyngeal, cervical, and anorectal. Join us as Drs. Anna Giuliano and Joel Heidelbaugh discuss strategies for improving HPV vaccination rates across different populations and provide specifics on how and when to use shared clinical decision-making (SCDM) when offering a permissive recommendation.=

Value-based care has emerged as an alternative and potential replacement for traditional fee-for-service reimbursement, centering quality and outcomes rather than quantity. That is the theory. In practice, value-based care has been shown to exacerbate some disparities in the healthcare system by making it harder for those patients with complex conditions, or being impacted by social determinants of health, to access care. Put simply, if some categories of patient are more financially risky than others to treat, providers may find ways to exclude them – unless checks and balances are put in place to help manage risks associated with SDOH and comorbid conditions. Health policy expert Matt Reiter hosts a discussion featuring Bill Finerfrock from Capitol Associates, and Tom Dorney from The Root Cause Coaltion. Together they discuss the very real danger of widening health disparities resulting from the expansion of value-based care, and the legislative solution proposed by the John Lewis EMMT Act (Equality in Medicare and Medicaid Treatment) which has been reintroduced in 2023 by Rep. Teri Sewell and Sen. Cory Booker. All organizations advocating for health equity are encouraged to help advance the legislation by writing letters of support (template below) to Matt Reiter reiterm@capitolassociates.com who will coordinate their forwarding to Representative Sewell and Senator Booker.   ------------------------------ LETTER OF SUPPORT TEMPLATE  Dear Representative Sewell & Senator Booker,  I am writing in support of S.1296/H.R.3069, the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act of 2023. The EMMT Act would require the Center for Medicare and Medicaid Innovation (CMMI) to include experts in health disparities and social determinants of health as part of the evaluation and review process for new payment models. If enacted, this bill would also require fairness of these new payment methods for women, high-risk patients, patients from racial or ethnic minorities, or patients from rural communities. Lastly, it directs CMMI to develop and test a payment model that is tailored to addressing social determinants of health. While quality and cost are important considerations, equal consideration should be given to the impact a proposed model may have on access to care for women, minorities and beneficiaries residing in rural areas. CMMI is under no statutory obligation to account for social determinants of health when considering new payment models. Indeed, the only factors CMMI must consider when determining whether to approve a new payment model are quality and cost. Because Medicare is the single largest health care payer in the country, and many commercial insurance plans will adopt policies based on Medicare, Congress must ensure that the models approved by CMMI incentivize reductions in minority and rural health disparities and not create barriers to care. We appreciate all that this CMS Administration has done to advance health equity. Passing the EMMT Act will ensure that all new models account for social determinants of health and how the models impact minority and rural populations. Your leadership on eliminating health disparities for women, minorities and beneficiaries residing in rural areas is deeply appreciated. I applaud your leadership on this important bill. The EMMT Act will go a long way towards improving access to quality healthcare for Medicare and Medicaid beneficiaries. On behalf or our organization:  Sincerely, ------------------------------ Health Disparities Podcast Episode 143 (c) Movement is Life 2023

An HRS meeting recap, Impella failure, sacubitril/valsartan, the purpose of trials, and a major breakthrough in evidence generation are the topics discussed by John Mandrola, MD in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. HRS Meeting Recap II. Impella in VT ablation - First-in-human Experience with Impella 5.0/5.5 for High-Risk Patients with Advanced Heart Failure Undergoing VT Ablationhttps://www.jacc.org/doi/10.1016/j.jacc.2023.05.012 III. Sacubitril/Valsartan ARNI Bests ARB to Reduce NT-proBNP in Stabilized Preserved-EF HF https://www.medscape.com/viewarticle/992461 - Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure https://www.jacc.org/doi/10.1016/j.jacc.2023.04.019 - Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/nejmoa1908655 - Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF https://doi.org/10.1093/eurheartj/ehad344 - Bogdan Tweet https://twitter.com/bogdienache/status/1660356776204595201?s=20 IV. Big Change in Reporting of Medical Evidence – Elan Trial - Early versus Later Anticoagulation for Stroke with Atrial Fibrillationhttps://www.nejm.org/doi/full/10.1056/NEJMoa2303048 - Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN): Protocol for an international, multicentre, randomised-controlled, two-arm, open, assessor-blinded trial https://doi.org/10.1177/23969873221106043 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

In this episode, we dive deeper into the controversy surrounding using high-flow nasal cannula vs NIV in high-risk patients to prevent reintubation. The recently published trial raised some crucial questions and forced us to reconsider our overall approach to extubation in this subset of patients. 

Drs Michael S. Saag and Monica Gandhi discuss COVID-19 and the impact this pandemic has had on patients diagnosed with HIV, including vaccines, boosters, and patients who are older or have chronic comorbid conditions. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986505). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Coronavirus Disease 2019 (COVID-19) https://emedicine.medscape.com/article/2500114-overview HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview HIV https://www.who.int/news-room/fact-sheets/detail/hiv-aids Molnupiravir, an Oral Antiviral Treatment for COVID-19 https://pubmed.ncbi.nlm.nih.gov/34159342/ Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients https://pubmed.ncbi.nlm.nih.gov/34914868/ Molnupiravir for the Treatment of COVID-19 in Immunocompromised Participants: Efficacy, Safety, and Virology Results From the Phase 3 Randomized, Placebo-Controlled MOVe-OUT Trial https://pubmed.ncbi.nlm.nih.gov/36648627/ Molnupiravir Plus Usual Care Versus Usual Care Alone as Early Treatment for Adults With COVID-19 at Increased Risk of Adverse Outcomes (PANORAMIC): An Open-Label, Platform-Adaptive Randomised Controlled Trial https://pubmed.ncbi.nlm.nih.gov/36566761/ Paxlovid https://pubmed.ncbi.nlm.nih.gov/35138785/ Protease Inhibitors as Promising Weapons Against COVID-19: Focus on Repurposing of Drugs Used to Treat HIV and HCV Infections https://pubmed.ncbi.nlm.nih.gov/34727849/ A Trial of Lopinavir-Ritonavir in Adults Hospitalized With Severe Covid-19 https://pubmed.ncbi.nlm.nih.gov/32187464/ Tenofovir Disoproxil Fumarate and Coronavirus Disease 2019 Outcomes in Men With HIV https://pubmed.ncbi.nlm.nih.gov/35848570/ Development of COVID-19 Vaccines–An Unanticipated Moon Shot Achieved at Warp Speed https://pubmed.ncbi.nlm.nih.gov/36689231/ Emerging Viral Diseases From a Vaccinology Perspective: Preparing for the Next Pandemic https://pubmed.ncbi.nlm.nih.gov/29199281/ A Bivalent Omicron-Containing Booster Vaccine Against Covid-19 https://pubmed.ncbi.nlm.nih.gov/36112399/ New Boosters Are Here! Who Should Receive Them and When? https://pubmed.ncbi.nlm.nih.gov/36354037/ Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients https://pubmed.ncbi.nlm.nih.gov/35653428/ Nirmatrelvir Use and Severe Covid-19 Outcomes During the Omicron Surge https://pubmed.ncbi.nlm.nih.gov/36001529/

In this episode, Dr. Neil Skolnik and Dr. Leana S. Wen discuss addressing unmet needs in the management of COVID-19. They will discuss the importance of layering mitigation and protection strategies for those who are most at risk, along with the role of long-acting monoclonal antibodies for COVID-19 pre-exposure prophylaxis with emphasis on patients who are immunocompromised and may not respond to vaccination, in light of evolving variants.This episode is part three of a three part series that examines the use of tixagevimab and cilgavimab for pre-exposure prophylaxis of COVID-19.  Funds for this activity have been provided by AstraZeneca.This activity does not offer CME/CE creditFaculty:Neil Skolnik, MDProfessor of Family and Community MedicineSidney Kimmel Medical CollegeThomas Jefferson UniversityAssociate DirectorFamily Medicine Residency ProgramAbington Jefferson HealthPhiladelphia, PALeana S. Wen, MD, MScProfessor, Health Policy and ManagementDistinguished Fellow, Fitzhugh Mullan Institute forHealth Workforce EquityGeorge Washington University School of Public Health Washington, DCPlease visit http://naceonline.com to engage in more live and on demand CME/CE content.

In this episode, Associate Editor, Dr. Robert Zeiser and Dr. Yi-Bin Chen discuss the series on How I Manage High-Risk Patients Following Allogeneic Hematopoietic Cell Transplantation.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Go online to PeerView.com/EPX860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Statin therapy is the cornerstone treatment for dyslipidemia, yet many patients are unable to attain recommended lipid goals with these oral therapies alone. PCSK9-targeting therapies, including monoclonal antibodies and small-interfering RNA, have been shown to reduce LDL-C levels by half, but questions surround the use of these agents and their associated outcomes. In this activity, based on a recent live symposium, leading experts discuss the latest data for these newer targeted therapies and offer evidence-based strategies to better individualize care to improve clinical outcomes, especially in patients with high ASCVD risk. Apply treatment guidelines for the management of hyperlipidemia, for both primary and secondary prevention of cardiovascular events, in patients with ASCVD; Identify the latest clinical evidence, mechanisms of action, and cardiovascular outcomes of approved and emerging non-statin, lipid-lowering therapies, especially PCSK9-targeting agents for managing hyperlipidemia in the ASCVD setting; and Individualize treatment regimens to reduce cardiovascular events in high-risk patients with hyperlipidemia consistent with consensus recommendations and recent clinical evidence available for novel lipid-lowering therapies.

Dr. Robert Jarve is the Associate Chief Medical Officer for Population Health at Corewell Health West. In this role, he leads the strategy and development of population health analytics capabilities for the system, as well as the implementation of a value-based care model for underserved, high-risk patients. He is also leading a pilot to help house at-risk patients who are experiencing homelessness.In addition to his administrative responsibilities, Dr. Jarve practices as an internal medicine and pediatrics physician, providing primary care to high-risk patients one day a week. He has diverse experience in population health management, including implementing and leading care management teams, developing care pathways and analytics solutions, and leading the change management of health care teams to more integrated team care models. Dr. Jarve holds BS and MSc degrees from Michigan State University, an MD degree from Wayne State University, and an MBA from Grand Valley State University.Dr. Jarve has lived in Michigan his whole life and enjoys spending time with his wife, two teenage boys, and pets. Outside work, his favorite activities are hiking, reading, traveling, and snowboarding. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Adria Grillo-Peck, vice president of integrated care management at IU Health, discusses issues related to care coordination for high-risk patients.

Teams from the Mass General Brigham health system and the Commonwealth Care Alliance, both in Massachusetts, have collaborated on a value-based care initiative with the principal goals of improving patient clinical outcomes, reducing unnecessary health care utilization, and making care more accessible. iCMP PLUS (Patients Linked to Urgent Support) is an integrated care management program providing intensive, multidisciplinary care to the highest-risk dual-eligible patients with Medicaid ACO coverage who have complex medical needs and high health care costs. Care team members meet patients where they are, demonstrating the effectiveness of community-based care management support programs. On this episode of Managed Care Cast, we speak with Jack Rowe, MD, MPH, and Lori Tishler, MD, MPH, 2 authors of “Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation,” published in the September issue of The American Journal of Managed Care®, about their findings on the program's effectiveness from its early phase of implementation.

A potential new anticoagulant, surveillance stress testing, a trial misinterpretation, an old diuretic, and AI in cardiology are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Factor XI inhibitors - Factor XIa Inhibitor After MI, Stroke Encouraging in Early Phase 2 Studies https://www.medscape.com/viewarticle/979942 - AXIOMATIC-SSP: Cautious Optimism on Factor XI Inhibitor in Stroke https://www.medscape.com/viewarticle/979860 II. Surveillance Stress Testing - No Benefit of Routine Stress Test POST-PCI in High-Risk Patients https://www.medscape.com/viewarticle/979866 - Routine Functional Testing or Standard Care in High-Risk Patients after PCI https://www.nejm.org/doi/full/10.1056/NEJMoa2208335 III. New Diuretic for Acute Heart Failure - Vintage Drug Atop IV Loop Diuretics Boosts Decongestion in ADHF: ADVOR https://www.medscape.com/viewarticle/979851 - Acetazolamide in Acute Decompensated Heart Failure with Volume Overload https://www.nejm.org/doi/full/10.1056/NEJMoa2203094 IV. AI in Cardiology - In Blinded Trial, Artificial Intelligence Beats Sonographers for Echo Accuracy https://www.medscape.com/viewarticle/979857 - Video-based AI for beat-to-beat assessment of cardiac function https://www.nature.com/articles/s41586-020-2145-8 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Medscape A potential new anticoagulant, surveillance stress testing, a trial misinterpretation, an old diuretic, and AI in cardiology are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Factor XI inhibitors - Factor XIa Inhibitor After MI, Stroke Encouraging in Early Phase 2 Studies https://www.medscape.com/viewarticle/979942 - AXIOMATIC-SSP: Cautious Optimism on Factor XI Inhibitor in Stroke https://www.medscape.com/viewarticle/979860 II. Surveillance Stress Testing - No Benefit of Routine Stress Test POST-PCI in High-Risk Patients https://www.medscape.com/viewarticle/979866 - Routine Functional Testing or Standard Care in High-Risk Patients after PCI https://www.nejm.org/doi/full/10.1056/NEJMoa2208335 III. New Diuretic for Acute Heart Failure - Vintage Drug Atop IV Loop Diuretics Boosts Decongestion in ADHF: ADVOR https://www.medscape.com/viewarticle/979851 - Acetazolamide in Acute Decompensated Heart Failure with Volume Overload https://www.nejm.org/doi/full/10.1056/NEJMoa2203094 IV. AI in Cardiology - In Blinded Trial, Artificial Intelligence Beats Sonographers for Echo Accuracy https://www.medscape.com/viewarticle/979857 - Video-based AI for beat-to-beat assessment of cardiac function https://www.nature.com/articles/s41586-020-2145-8 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net https://www.listennotes.com/e/ba6a68de5a974e10b6e0df1d3cdecb7b/

Adjuvant Therapy for Patients With Resected Melanoma: Finessing Care to Improve Survival in High-Risk Patients

https://veterinarydentistry.net/radiographic-interpretation-online-training/

Description: COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel anti-viral agent that showed promise in an initial industry-sponsored trial among unvaccinated patients with the delta strain. But does it hold up in the real world where vaccination is common, and omicron has pushed delta to the wayside? Dr. Jarvis reviews the initial RCT and a recent Israeli observational trial where more than 75% of patients were vaccinated. He also covers the contraindications for its use. Finally, he'll no doubt massacre the almost impossible-to pronounce generic names for the drugs in Paxlovid. Citations. 1. Najjar-Debbiny R, Gronich N, Weber G, et al. Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients. Clinical Infectious Diseases. Published online June 2, 2022:ciac443. doi:10.1093/cid/ciac443 2.Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542See omnystudio.com/listener for privacy information.

In this episode, Marc and Mo discuss 3 recent articles that caught their eye. The first part of the discussion focuses on the importance of blinded assessment of outcomes in clinical trials, and the second part focuses on the use of tranexamic acid in patients with hip fractures. Links: Metcalfe A, Parsons H, Parsons N, Brown J, Fox J, Gemperlé Mannion E, Haque A, Hutchinson C, Kearney R, Khan I, Lawrence T, Mason J, Stallard N, Underwood M, Drew S; START:REACTS team. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. Lancet. 2022 May 21;399(10339):1954-1963. doi: 10.1016/S0140-6736(22)00652-3. Epub 2022 Apr 21. PMID: 35461618. https://bit.ly/3P62z0I Verma N, Srikumaran U, Roden CM, Rogusky EJ, Lapner P, Neill H, Abboud JA; SPACE GROUP. InSpace Implant Compared with Partial Repair for the Treatment of Full-Thickness Massive Rotator Cuff Tears: A Multicenter, Single-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am. 2022 Apr 22. doi: 10.2106/JBJS.21.00667. Epub ahead of print. PMID: 35777921. https://bit.ly/3cBTmz6 Porter SB, Spaulding AC, Duncan CM, Wilke BK, Pagnano MW, Abdel MP. Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Intertrochanteric Fracture. J Bone Joint Surg Am. 2022 Jul 6;104(13):1138-1147. doi: 10.2106/JBJS.21.01389. Epub 2022 Apr 29. PMID: 35775092. https://bit.ly/3AHrhjT POISE Study Group, Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, Xavier D, Chrolavicius S, Greenspan L, Pogue J, Pais P, Liu L, Xu S, Málaga G, Avezum A, Chan M, Montori VM, Jacka M, Choi P. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47. doi: 10.1016/S0140-6736(08)60601-7. Epub 2008 May 12. PMID: 18479744. https://pubmed.ncbi.nlm.nih.gov/18479744/ Subspecialties: Shoulder Trauma Hip Orthopaedic Essentials

This podcast covers the JBJS July 6, 2022 issue. Featured are articles covering TXA Not Associated with Increased Complications in High-Risk Patients with IT Fracture; recorded commentary by Dr. Cornell; Histologic Differences in Human Rotator Cuff Muscle Based on Tear Characteristics.

In this episode, Antonia and Andrew discuss a selection of articles from the July 6, 2022 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold! Articles Discussed: Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents, by Krakow et al. Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Intertrochanteric Fracture, by Porter et al. Arthroscopic Versus Open Ankle Arthrodesis. A 5-Year Follow Up, by Abuhantash et al. Modular Fluted Tapered Stems for Periprosthetic Femoral Fractures. Excellent Results in 171 Cases, by Hannon et al. Histologic Differences in Human Rotator Cuff Muscle Based on Tear Characteristics, by Ruderman et al. Racial, Ethnic, and Gender Diversity in Academic Orthopaedic Surgery Leadership, by Meadows et al. Surgical Anatomy of the Radial Nerve at the Dorsal Region of the Humerus. A Cadaveric Study, by Welle et al. Internal Torsion of the Knee. An Embodiment of Lower-Extremity Malrotation in Patients with Patellar Instability, by Qiao et al. Transphyseal Distal Humeral Fractures. A 13-Times-Greater Risk of Non-Accidental Trauma Compared with Supracondylar Humeral Fractures in Children Less Than 3 Years of Age, by Crowe et al. Link: JBJS website: https://jbjs.org/issue.php Sponsor: This episode is brought to you by JBJS Clinical Classroom. Subspecialties: Basic Science Trauma Pediatrics Shoulder Sports Medicine Orthopaedic Essentials Hip Foot &

Contributor: Nick Hatch, MD Educational Pearls: Transcatheter aortic valve replacement (TAVR) is an increasingly common endovascular procedure to treat aortic stenosis TAVR is an alternative to the open approach surgical aortic valve replacement (SAVR) for patients who are inoperable or are high risk surgical candidates Following TAVR, there is increased risk of stroke, particularly in the first 30 days TAVR-related strokes are due to embolic debris left on the valve root, which is generally cleaned out during SAVR Further, following the procedure many patients are anticoagulated which increases the risk for conversion to hemorrhagic stroke Isolated, unexplained nausea and vomiting in elderly patients should prompt concern for a neurologic workup with imaging - even more so if they have recently undergone TAVR  References Davlouros PA, Mplani VC, Koniari I, Tsigkas G, Hahalis G. Transcatheter aortic valve replacement and stroke: a comprehensive review. J Geriatr Cardiol. 2018;15(1):95-104. doi:10.11909/j.issn.1671-5411.2018.01.008 Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients. J Am Coll Cardiol. 2018;72(22):2687-2696. doi:10.1016/j.jacc.2018.08.2146 Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40(38):3143-3153. doi:10.1093/eurheartj/ehz275 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

How has the wavelike nature of COIVD-19 defined the pandemic and the virus driving it? Host Jared explores this phenomenon in depth by looking over statistics of the virus in various countries from 2020 to today. Since the last wave, he highlights a shift in how the virus has been perceived psychologically by society. Finally, he wraps up the episode by explaining tools which could hypothetically help society exit the pandemic once and for all while bracing for another potentially impactful wave of COVID-19. References Johns Hopkins University of Medicine Coronavirus Resource Center New COVID-19 Cases Worldwide Understanding Vaccination Progress Cautious Optimism and Considerations for Health Providers and Patients: Oral Antiviral for Early Treatment of High-Risk Patients and Vaccines for Prevention of COVID-19 Experimental COVID-19 vaccine provides mutation-resistant T cell protection in mice Facing funding crisis, White House warns of COVID-19 surge in fall Fact Sheet: Biden Administration Underscores Urgent Need for Additional COVID-⁠19 Response Funding and the Severe Consequences of Congressional Inaction

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Thromboprophylaxis after discharge improves clinical outcomes for certain high-risk patients hospitalized with COVID-19 (MICHELLE) '

C. Michael Gibson and Pieter C. Smits review outcomes in high-bleeding-risk patients also at high risk for thrombotic events who were randomized to abbreviated DAPT.

The world of COVID-19 is always changing. Join Geoff Wall for a rapid fire of updates regarding famotidine, lockdowns, and ivermectin as evaluated for efficacy in COVID-19.The GameChangersThe use of high-dose famotidine in the treatment of COVID-19 has demonstrated moderate safety, but questionable efficacy. Additionally, a recent meta-analysis examining the efficacy of lockdown on the spread of COVID-19 had several limitations that should be taken into consideration. Show Segments00:00 – Introductions01:56 – Famotidine in the Treatment of COVID-1910:52 – Effects of Lockdown on COVID-19 Mortality 18:26 – Ivermectin Treatment of COVID-19 in High-Risk Patients 23:45 – Closing Remarks HostGeoff Wall, PharmD., BCPS, FCCP, CGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthRedeem your CPE or CME credit here!Pharmacist membersCMENeed a membership?Join for CPE CreditJoin for CME Credit References and resources:References and resources:1.     Oral Famotidine Versus Placebo in Non-Hospitalised Patients with COVID-19: A Randomised, Double-Blind, Data-Intense, Phase 2 Clinical Trial 2.     A Literature Review and Meta-Analysis of the Effects of Lockdowns on COVID-19 Mortality. Pre-Publication.3.     Efficacy of Ivermectin Treatment on Disease Progression Among Adults with Mild to Moderate COVID-19 and ComorbiditiesContinuing Education Information:Learning Objectives:1. Describe the latest information on masks and other non-pharmacologic interventions to halt the spread of COVID-192. Discuss the recent randomized controlled trial evaluating famotidine use in early COVID-19 positive patientsDr. Wall is a member of the Janssen Speaker's Bureau.0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-22-142-H01-PInitial release date: 03/28/22Expiration date: 03/28/2023

Where are the biggest cardiovascular benefits for your patients with type 2 diabetes? Host Dr Silvio Inzucchi and cardiologist Dr Mikhail Kosiborod reveal winning strategies — for managing much more than just type 2 diabetes. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963270). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources New ACC Guidance on CVD Risk Reduction in Diabetes https://www.medscape.com/viewarticle/935218 Type 2 Diabetes in Adults: Management https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management Type 2 Diabetes and Causes of Sudden Cardiac Death: A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525691/ Cardiometabolic Medicine – the US Perspective on a New Subspecialty https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410029/pdf/xce-9-070.pdf Antidiabetics, Glucagon-like Peptide-1 Agonists https://reference.medscape.com/drugs/antidiabetics-glucagon-like-peptide-1-agonists Antidiabetics, SGLT2 Inhibitors https://reference.medscape.com/drugs/antidiabetics-sglt2-inhibitors Dulaglutide and Cardiovascular Outcomes in Type 2 Diabetes (REWIND): A Double-Blind, Randomised Placebo-Controlled Trial https://pubmed.ncbi.nlm.nih.gov/31189511/ Mechanistic Insights Regarding the Role of SGLT2 Inhibitors and GLP1 Agonist Drugs on Cardiovascular Disease in Diabetes https://pubmed.ncbi.nlm.nih.gov/31381891/ SGLT2 Inhibitors for Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Systematic Review and Meta-analysis of Cardiovascular Outcome Trials https://pubmed.ncbi.nlm.nih.gov/30424892/ Empagliflozin in Patients With Heart Failure, Reduced Ejection Fraction, and Volume Overload: EMPEROR-Reduced Trial https://pubmed.ncbi.nlm.nih.gov/33736819/ Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/nejmoa1812389 CV Protection in the EMPA-REG OUTCOME Trial: A "Thrifty Substrate" Hypothesis https://diabetesjournals.org/care/article/39/7/1108/37341/CV-Protection-in-the-EMPA-REG-OUTCOME-Trial-A Worldwide Inertia to the Use of Cardiorenal Protective Glucose-Lowering Drugs (SGLT2i and GLP-1 RA) in High-Risk Patients with Type 2 Diabetes https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01154-w Albiglutide and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Cardiovascular Disease (Harmony Outcomes): A Double-Blind, Randomised Placebo-Controlled Trial https://pubmed.ncbi.nlm.nih.gov/30291013/ High-Sensitivity C-Reactive Protein https://emedicine.medscape.com/article/2094831-overview#:~:text=hs%2DCRP%20is%20an%20important,predicts%20mortality%20and%20cardiac%20complications. Optimal Use of SGLT2 Inhibitors and GLP-1 Agonists: 5 Things to Know https://www.medscape.com/viewarticle/960356 Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/34215025/ Coronary Artery Calcification on CT Scanning https://emedicine.medscape.com/article/352189-overview

How should the patient with diabetes who is at risk of developing heart failure be managed? What medication is needed and how important is prevention through diet and exercise? Visit www.morningcommutepodcast.com/heartfailure3 to view the activity and CME/CE information, download the transcript, and complete the post-test and evaluation to earn CME/CE credit

Join EHRA 2021 guideline editors as they summarize the practical recommendations on the use of NOACs in AF. Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/968504?src=mkm_podcast_addon_968504

The findings of TWILIGHT Trial

輝瑞宣布其研發的抗新冠口服藥可以降低89%的住院或死亡風險 默克的 Molnupiravir 莫納皮拉韋出現強勁對手！ 輝瑞，又是輝瑞......疫苗也是你，藥物也是你@@ 1.先提醒，這是新聞稿，詳細的資料還沒有公布。 2.藥物商品名：PAXLOVID™ (PF-07321332; ritonavir) 是蛋白酶抑制劑的組合。PF-07321332是新藥，加上老藥抗愛滋藥物低劑量ritonavir的目的不是抗病毒效果，而是減緩新藥代謝的速度，從而增加新藥濃度。這是在抗愛滋藥物中已經經過長期使用的做法。 3.Phase 2/3 EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) 是隨機，雙盲的臨床試驗，從7月開始收案，原本預計收案3000人。收案條件是在發病五天內，輕症到中症的新冠確診病患。且因為主要想看藥物是否可以減少住院和重症，收案者需要至少有一個易重症高風險因子。此收案條件和莫納皮拉韋一模一樣。 4.目前是期中分析在9月29日前收案的1219人。若在有症狀3天內就服用藥物，用藥組389人中僅3人需要住院，0人死亡。對照組385人中27人需要住院，其中7人死亡。達到統計學上顯著意義。 (p

Enhance your emergency department with a state-of-the-art remote patient monitoring system. Sotera Wireless, Inc. has developed the ViSi Mobile System to help clinicians and nurses care for high-risk ED patients. You can find out more at https://www.soterawireless.com (https://www.soterawireless.com)

Overview: This podcast discusses the identification and management of patients with atherosclerotic cardiovascular disease (ASCVD) and highlights opportunities to reduce the overall burden of elevated low-density lipoprotein cholesterol (LDL-C). Guest: Norman E. Lepor, MD, FACC, FAHA, FSCAI

Fluvoxamine was shown in the RCT to decrease the risk of hospitalization in high-risk patients. Show Notes: https://eddyjoemd.com/fluvoxamine/ Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Website: www.eddyjoemd.com Instagram: www.instagram.com/eddyjoemd Twitter: www.twitter.com/eddyjoemd Facebook: www.facebook.com/eddyjoemd Podcast: https://anchor.fm/eddyjoemd My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd --- Support this podcast: https://anchor.fm/eddyjoemd/support

This podcast covers the JBJS October 20, 2021 issue. Featured are articles covering Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients; recorded commentary by Dr. Azboy; Is Gastrocnemius Tightness a Normal Finding in Children?

When COVID-19 deaths occur in the hospital the most common finding is blood clots in the lungs and elsewhere in the body due to inadequate anticoagulation. Hopefully with these tips, for those who have COVID-19 or will get it soon, whether vaccinated or not, will be useful in keeping the syndrome to a mild 4-day cold and a deliverance to natural immunity...

When COVID-19 deaths occur in the hospital the most common finding is blood clots in the lungs and elsewhere in the body due to inadequate anticoagulation. Hopefully with these tips, for those who have COVID-19 or will get it soon, whether vaccinated or not, will be useful in keeping the syndrome to a mild 4-day cold and a deliverance to natural immunity...

In this episode, we will be welcoming Dr. Mary Landrigan-Ossar, a Senior Associate in Perioperative Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. Dr. Landrigan is also an Assistant Professor of Anesthesia at Harvard Medical School. She has been involved with the Society for Pediatric Sedation for a long time and serves on the executive committee as well as the board of directors. Dr. Landrigan comes on to help us gather insight on how sedation practitioners should approach procedural sedation in high risk patients outside of the operating room where they focus on pre-screening prior to procedural sedation. Join us to learn moreShow HighlightsWhy it's so important to assess a child's risk profile prior to procedural sedation (01:29)Patient risk factors associated with sedation related adverse events (03:02)Concerns regarding the sedation of infants where the infants are under 3 months of age (04:50)How prematurity poses a risk for sedation related adverse events (06:24)The relation between obesity and increased risk for adverse events in procedural sedation (07:58)Risks posed to procedural sedation by children that have upper respiratory tract infections (09:11)Scenario where a child snores like an adult while sleeping or has noisy breathing during sleep (11:07)Dealing with children who have heart disease when they are presented for procedural sedation (13:34)Different instances where sedation practitioners should be very cautious and consult an anesthesiologist (17:53)Clinical pearls in sedating high risk patients and the necessary careful pre-screening required for such patients (20:08)Resources:Society of Pediatric Sedation Website

Cases in Osteoporosis: Breaking Down Important Care Decisions for Very High-Risk Patients

Umbótavika er haldin á Landspítala 25.–28. maí til að hvetja starfsfólk áfram í umbótastarfi og veita því innblástur um leið og sagt er með fjölbreytilegum hætti frá árangursríkum verkefnum. Þessi fjórði þáttur Umbótavarpsins fjallar um tvö umbótaverkefni. Guðbjörg Pálsdóttir sérfræðingur í hjúkrun segir frá þrýstingssáraverkefninu HAMUR og Amelia Samuel greinir frá vitundarvakningu Alþjóða heilbrigðismálastofnunarinnar WHO sem hefur yfirskriftina "Lyf án skaða" eða "Medication Without Harm".Hlaðvarp Landspítala er aðgengilegt á vef spítalans og helstu samfélagsmiðlum, en einnig í streymisveitunum Spotify og Apple iTunes, ásamt hlaðvarpsveitum á borð við Simplecast, Pocket Casts og Podcast Addict. Það er samskiptadeild Landspítala sem heldur úti Hlaðvarpi Landspítala og þeim sjálfstæðu þáttasyrpum sem tilheyra hlaðvarpsfjölskyldu spítalans.SIMPLECASThttps://landspitalihladvarp.simplecast.com/episodes/umbotavarp-04 

Although Covid-19 primarily manifests as a respiratory syndrome, its reach can extend to many other organs like the kidney, heart & brain, with devastating consequences. The consequences of the COVID-19 pandemic have been devastating; however, evidence suggests that patients with, or at risk of, kidney disease are disproportionately affected. What has been observed in the past year of the pandemic? Melisa Idris and Sharaad Kuttan speak to Dr Rafidah Abdullah is a Consultant Physician & Nephrologist at Hospital Putrajaya.

This is the third episode in a series of podcasts following the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, on the topic of circulating tumor DNA (ctDNA) in the management of lymphoma. The Lymphoma hub asked Alex Herrera, City of Hope Comprehensive Cancer Center, Duarte, US, Does ctDNA add value to current prognostic markers for identifying high-risk patients?ctDNA can be a useful tool for identifying residual disease after the initiation of treatment, and it can also be used as a prognostic factor for outcome with a particular treatment.In this podcast, Herrera discusses the results of a phase Ib/II study evaluating the prognostic value of ctDNA for identifying patients with relapsed/refractory diffuse large B-cell lymphoma, receiving polatuzumab + bendamustine and rituximab versus bendamustine and rituximab alone, at higher risk for disease progression. Hosted on Acast. See acast.com/privacy for more information.

In this episode, Dr Rónán Collins talks about the links between atrial fibrillation and renal impairment, Dr Hendrik Bonnemeier takes us through the RELOADED study and Dr Manesh Patel and Dr Christian Ruff discuss the management of an patient with atrial fibrillation, diabetes and renal impairment. Further Details: •The 2018 EHRA Practical Guide on the use of NOACs in patients with atrial fibrillation can be found here https://academic.oup.com/eurheartj/article/39/16/1330/4942493 •The meta-analysis of the phase III trials of NOACs by Ruff et al. is available here https://pubmed.ncbi.nlm.nih.gov/24315724/ •Recent presentations of data from RELOADED can be found here (https://esc365.escardio.org/vgn-ext-templating/Congress/ESC-CONGRESS-2019/Poster-Session-5-Atrial-fibrillation-and-oral-anticoagulation-6/199357-comparative-safety-of-factor-xa-inhibitors-vs-phenprocoumon-in-patients-with-non-valvular-atrial-fibrillation-and-renal-disease-insights-from-the-reloaded-study#slide) and here (https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Poster-Session-5-Atrial-fibrillation-and-oral-anticoagulation-1/199283-renal-function-worsening-in-factor-xa-inhibitors-vs-phenprocoumon-in-patients-with-non-valvular-atrial-fibrillation-and-renal-disease-insights-from-the-reloaded-study) and RELOAD is published here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510975/). •Thrombosis Adviser's coverage of ESC 2019 is here (https://www.thrombosisadviser.com/esc-spaf/) •The 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society Focused Update of the Guideline for the Management of Patients With Atrial Fibrillation is available here https://www.ncbi.nlm.nih.gov/pubmed/3070343 •The European Society of Cardiology Guidelines for the Management of Atrial Fibrillation can be read here https://www.ncbi.nlm.nih.gov/pubmed/16531986 •For anticoagulant dosing information see the European labels for apixaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf), dabigatran (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf), edoxaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf), rivaroxaban (https://www.ema.europa.eu/documents/product-information/xarelto-epar-product-information_en.pdf) and warfarin (https://www.medicines.org.uk/emc/product/3064/smpc) Recording approval code: PP-XAR-ALL-1963-1; Shownotes approval code: PP-M_RIV-ALL-0127-1

In this episode, Professor Peter Rossing talks about the links between atrial fibrillation and diabetes, Professor Craig Coleman takes us through the RIVAL study and Dr Manesh Patel and Dr Christian Ruff discuss the management of an obese patient with atrial fibrillation and diabetes. Further Details: Details on the affect that diabetes has on stroke risk in patients with atrial fibrillation can be found on our page on Thrombosis Adviser (https://www.thrombosisadviser.com/diabetes). Data showing how diabetes doubles the rate of renal decline over 2 years are available in this publication (https://www.ncbi.nlm.nih.gov/pubmed/27073197) Full results of the RIVAL study are presented here (https://pubmed.ncbi.nlm.nih.gov/31392894/) Subanalyses of the ROCKET AF trial that look at the effect of rivaroxaban on atherosclerotic events in patients with atrial fibrillation can be seen here (https://pubmed.ncbi.nlm.nih.gov/24132190/) (for coronary events) and here (https://pubmed.ncbi.nlm.nih.gov/24302273/) for limb events The MarketScan analysis looking at major cardiovascular or limb events in patients with atrial fibrillation and diabetes are published here (https://dom-pubs.onlinelibrary.wiley.com/doi/abs/10.1111/dom.13787) The 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society Focused Update of the Guideline for the Management of Patients With Atrial Fibrillation is available here (https://www.ncbi.nlm.nih.gov/pubmed/30703431) More information on COMPASS and VOYAGER PAD can be found on VascularAdviser.com (https://www.thrombosisadviser.com/en/vascular-protection/) The European Society of Cardiology Guidelines for the Management of Atrial Fibrillation can be read here (https://www.ncbi.nlm.nih.gov/pubmed/16531986) For anticoagulant dosing information see the European labels for apixaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf), dabigatran (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf), edoxaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf), rivaroxaban (https://www.ema.europa.eu/documents/product-information/xarelto-epar-product-information_en.pdf) and warfarin (https://www.medicines.org.uk/emc/product/3064/smpc) Recording approval code: PP-XAR-ALL-1885-1; Shownotes approval code: PP-M_RIV-ALL-0111-1

In this episode, Dr Yassir Javaid gives us his advice on getting to know your patients with atrial fibrillation and diabetes , Professor Craig Coleman explains the results of the CALLIPER study and Dr Manesh Patel and Dr Christian Ruff look at the issues surrounding stroke prevention in an older patient with renal impairment and tell us how COVID-19 is affecting the treatment of patients with cardiovascular disease. Further Details • For more information on the number of strokes that can be prevented click here https://eiuperspectives.economist.com/healthcare/policy-approaches-stroke-prevention/white-paper/preventing-stroke-uneven-progress • Details on the number of patients of atrial fibrillation and comorbid diabetes can be found on our page on Thrombosis Adviser https://www.thrombosisadviser.com/diabetes • Data showing how diabetes doubles the rate of renal decline over 2 years are available in this publication https://pubmed.ncbi.nlm.nih.gov/27073197/ • Full results of the CALLIPER study are presented here https://academic.oup.com/eurheartj/article-abstract/40/Supplement_1/ehz745.1122/5596296?redirectedFrom=fulltext • The 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society Focused Update of the Guideline for the Management of Patients With Atrial Fibrillation is available here • The European Society of Cardiology Guidelines for the Management of Atrial Fibrillation can be read here https://pubmed.ncbi.nlm.nih.gov/16531986/ • For anticoagulant dosing information see the European labels for apixaban (https://www.ema.europa.eu/en/documents/product-information/eliquis-epar-product-information_en.pdf ), dabigatran (https://www.ema.europa.eu/en/documents/product-information/pradaxa-epar-product-information_en.pdf), edoxaban (https://www.ema.europa.eu/en/documents/product-information/lixiana-epar-product-information_en.pdf), rivaroxaban (https://www.ema.europa.eu/en/documents/product-information/xarelto-epar-product-information_en.pdf) and warfarin (https://www.medicines.org.uk/emc/product/3064/smpc) Recording approval code: PP-XAR-ALL-1800-1; Shownotes approval code: PP-M_RIV-ALL-0113-1

Now that there are confirmed cases of COVID-19 in Colorado, what should those at high-risk be doing? Then, understanding the incarceration rate of women. Plus, we meet musician Joe Johnson who found a new life in Colorado. Also, the family legacy of El Taco Rey. And we say good-bye to a dear friend.

Cancer Genetics and High Risk Patients with guest Amanda Ganzak February 23, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Cancer Genetics and High Risk Patients with guest Amanda Ganzak February 23, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Syncope is an incredibly common presentation to the Emergency Department with a broad differential diagnosis from the benign (vasovagal) to the lethal (arrhythmia). Because of this, the care and disposition of these patients can be challenging. In this podcast we sat down with Dr. Mike Burla to talk through the details of a new(er) decision aid- the Canadian Syncope Risk Score.   The paper we discuss can be found HERE Thiruganasambandamoorthy V et al. Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Circulation. 2019 Mar 12;139(11):1396-1406.     Check out our post on the Down East EM blog for shownotes, references, and more.   When listening to this post, please consider the following questions (and follow us on twitter for spaced retrieval of this material @downeastem): 1. How long did the CSRS study investigators observe patients for major arrhythmic outcomes after presentation to the ED?  2. Approximately what percentage of the study cohort was classified as low risk by the CSRS? 3. What proportion of serious arrhythmic outcomes occurred within 6 hours of ED arrival, regardless of CSRS score?  4. According to the study authors, what is the recommended time for observation of a low risk patient by CSRS? How about for Medium and High Risk Patients?  5. Based on the study results, what risk stratification category are the recommendations most applicable to? What is the recommendation for electrocardiographic monitoring of this group?    Authors: Mike Burla MD and Jason Hine MD Peer Review: Lauren Wendell MD

Several guidelines now recommend direct oral anticoagulants (DOACs) as the preferred anticoagulants for patients with non-valvular atrial fibrillation (a-fib). However, the landmark clinical trials focused largely on the primary prevention of stroke.  Moreover, real-world data using DOACs for secondary prevention is lacking. Many have argued that warfarin might be a better choice in these high-risk patients because it requires routine monitoring and increases the patient's contact with the healthcare system. Does the choice of anticoagulant make a difference in preventing recurrent stroke? Guest Authors: Blaire White, PharmD; Amber Cizmic, PharmD, BCACP; and Tish Smith, PharmD, BCACP Music by Good Talk

Acute Kidney Injury After Cardiac Surgery: Optimising Outcomes in High-Risk Patients

Acute Kidney Injury After Cardiac Surgery: Optimising Outcomes in High-Risk Patients

Acute Kidney Injury After Cardiac Surgery: Optimising Outcomes in High-Risk Patients

Acute Kidney Injury After Cardiac Surgery: Optimising Outcomes in High-Risk Patients

Balancing Safety With Stroke Prevention in High-Risk Patients With AF

Balancing Safety With Stroke Prevention in High-Risk Patients With AF

Balancing Safety With Stroke Prevention in High-Risk Patients With AF

Balancing Safety With Stroke Prevention in High-Risk Patients With AF

Michelle Snyder leads all corporate marketing, brand development, marketing communications and public relations activities for Welltok. She is recognized as a marketing and strategy leader in the digital health space. She was most recently an Executive-in-Residence at InterWest Partners, investing in digital health companies and serving as an advisor to InterWest portfolio companies. She was also one of the early executives at Epocrates and worked for over a decade to build the company into one of the leading mobile healthcare technology companies and the most recognized technology brand among clinicians. Previously, she worked as a health strategy consultant with the Wilkerson Group and in health policy formation and implementation with the Lewin Group and the Georgetown Center for Health Policy Studies. Michelle earned her bachelor's degree from Carleton College and MBA from Kellogg School of Management at Northwestern University. 00:00 Defining Artificial Intelligence within the Healthcare Space. 03:45 What AI training is. 05:00 Why asking questions is key. 05:30 Who is Watson? 06:50 How Watson trains in real-time with consumer feedback. 07:45 The advantage of having an AI answering consumer questions instead of a live medical professional. 08:20 The benefits of Cognitive Computing. 09:10 How AI has the potential to Personalize Healthcare. 10:50 Welltok's shortlist of things to improve. 12:30 How Watson can help consumers achieve their dietary goals. 13:40 How Predictive Analytics and Artificial Intelligence go together. 14:40 Getting the right people to the right platform. 16:00 Figuring out High Risk Patients by analyzing a consumer's personal viewpoints. 18:15 Predicting Patient Receptivity. 19:50 How Welltok's platform works, even in the absence of Watson. 23:00 Offering a unique and relevant pathway. 25:00 Mapping out what is most important. 27:00 How varying rewards can affect Patient Engagement. 28:50 Why Michelle uses the term ‘Consumers,' not ‘Patients.' 31:00 “30% of your health is genetic factors, but 70% is environmental.” 32:00 The difficulty in building a Health Platform around the idea of a Consumer, not a Patient. 33:00 You can find out more at www.welltok.com, or by emailing Michelle at optimizedhealth@welltok.com.

Host: Larry Kaskel, MD Guest: Sandeep Vijan, PhD What is the Cost Effectiveness of High-Dose Statin Therapy in High-Risk Patients with Coronary Artery Disease? Recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). However, the actual benefits and cost-effectiveness of high-dose statin therapy are still unknown. What can we deduct from this analysis, and will it affect how and when we prescribe high-does statins to our patients?